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Hypertension Meds Cheat Sheet by

Hypertension Medications
nursing     hypertension     pharmacology     medsurgnursing

Angiot­ensin II Receptor Blockers

Examples Cozaar (Losarten) Atacand (Cande­sarten) Diovan (Valsa­rtan)
MOA: Prevent action of A-II and produce vasodi­lation and increased salt and water excretion
Side effects Hyperk­alemia Impaired renal function
Drug Intera­ctions: None listed
Nursing Implic­ations Monitor b/p and heart rate Full effect may take 3-6 weeks Watch for hyperk­alemia and renal dysfun­ction

Patient Education

Screening B/P measur­ement Cardio­vas­cular risk factors
Therap­eutic regime Lifestyle modifi­cation Medication adherence

Nursing Management

Assessment History and physical exam BP measur­ement
Nursing Diagnoses Ineffe­ctive health mainte­nance Anxiety Sexual dysfun­ction
Goals Lower BP and enhance patient compliance
Interv­entions Early identi­fic­ation of medication side effects or compli­cations Patient and family education
Evaluation Achieve and maintain goal BP Unders­tand, accept, and implement therap­eutic plan Experience minimal or no side effects

Calcium Channel Blockers

Examples: Diltiazem (Cardizem SR) Nifedipine (Proca­rdia, Procardia XL, Adalat) Nicard­ipine (Cardene) Verapamil (Isoptin, Calan, Calan SR) Amlodipine (Norvasc)
Mechanism of action: Blocks movement of calcium into cells Vasodi­lat­ation, ↓ SVR, ↓ contra­cti­lity, ↓ HR
Side Effects: Bradyc­ardia, 1st degree AV heart block, nausea, headache, dizziness, peripheral edema, flushing, rash gingival hyperp­lasia, and consti­pation with verapamil.
Adverse drug Intera­ctions: Cautious use in patients with heart failure. Contra­ind­icated in patients with 2nd and 3rd degree heart block.
Avoid grapefruit juice
Watch for bradyc­ardia, first degree heart block
 

Diuretics

Thiazide
Loop
MOA: Inhibit NaCL reabso­rption in distal tubules. Initial decrease in ECF and sustained decrease in SVR. Lowers B/P over 2 -4 weeks.
MOA: Inhibits NaCl reabso­rption in the ascending limb of loop of Henle, Increase excretion NaCl.
Chloro­thi­azide (Diuril), hydroc­hlo­rot­hiazide (Micro­zide)
Furose­mide( Lasix), bumeta­nid­e(B­umex)
Side effects: fluid and E- imbalance, volume depletion, metabolic alkalosis. Vertigo, headache, weakness. Anorexia, N/V, consti­pation, pancre­atitis, sexual dysfun­ction, photos­ens­iti­vity, decreased glucose tolerance
Adverse rxn: Fluid and electr­olyte imbala­nces. Ototox­icity, vertigo, Metabolic: hyperu­rec­emia, hyperg­lyc­emia, inc. LDL and trigly­cerides and dec. HDL
Drug Intera­ctions: Potentiate digoxin NSAIDS may decrease diuretic and antihy­per­tensive effect
Drug Intera­ctions: None listed
Nursing Consid­era­tions: Monitor VS , orthos­tatic hypote­nsion, Monitor for hypoka­lemia. Teach about supple­men­tation with K+ rich foods
Nursing Interv­ent­ions: Monitor fluid and E imbalances

Diuretics

Potassium Sparing
Aldost­erone Receptor Blockers
MOA: Reduce K+ and Na+ exchange distal and collecting tubules reduce excretion of K+, H+, Ca+ and Mg+
MOA: inhibits Na+ retaining and K+ excreting effects of aldost­erone in distal and collecting tubules ( K+ sparing)
Amilor­ide­(Mi­damor
Spirol­act­one­(Al­dactone
Side effects: Hyperk­alemia: N/V, diarrhea, leg cramps, dizziness, Tall t waves
Side effects: Hyperk­alemia, gyneco­mastia, erectile dysfun­ction menstrual irregu­larity
Drug intera­ctions: Caution in pts on ACE inhibitors and Angiot­ensin II blockers avoid potassium supple­ments
Drug Intera­ctions: Do not combine with K+ sparing diuretics or supple­ments, cautious use with ACE Inhibitors or angiot­ensin II blockers
Nursing Interv­ent­ions: monitor for orthos­tatic hypote­nsion, contra­ind­icated in pts with renal failure and cautious use in pts on ACE inhibitors and Angiot­ensin II blockers. Avoid K+ supple­ments
NursNu­rsing Intera­ctions: monitor for orthos­tatic hypote­nsion and hyperk­ale­mia.ing Interv­ent­ions: Monitor fluid and E imbalances
 

Direct Vasodi­lators

Examples: Hydral­azine (Apres­oline) Minoxidil (Loniten) Sodium nitrop­uru­sside (Nipride)
Mechanism of action: Relax vascular smooth muscle Decrease SVR
Often given IV for hypert­ensive crisis
Side Effects: Reflex tachyc­ardia, nausea, flushing, headache, hypote­nsion
Nursing Interv­ent­ions: Monitor for hypote­nsion and tachyc­ardia

ACE Inhibitors

"­pri­l"
Examples: Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Ramipril (Altace) Benazepril (Lotensin) Quinapril (Accupril)
Mechanism of action: Inhibits angiot­ens­in-­con­verting enzyme Decreases vasoco­nst­riction and water retention
Side Effects: Cough: 1/3 will develop Hypote­nsion, Dizziness, headache, vertigo Angioedema Photos­ens­itivity Abdominal pain, loss of taste Hyperk­alemia: inhibits aldost­erone
Drug Intera­ctions: Diuretics enhance effect NSAIDS and ASA may reduce effect
Nursing Implic­ations Monitor blood pressure Monitor serum potassium Monitor renal function Antacids may decrease absorption
 

Beta Blockers

Beta Blockers “-olol”
Metrop­olo­l(L­opr­essor), propan­olo­l(I­nde­ral), carved­iol­(Coreg)
Mechanism of action: Block beta receptor sites which are responsive to epinep­hrine and norepi­nep­hrine..
Side Effects Hypote­nsion Headache Fatigue Peripheral edema Erectile dysfun­ction Diabetics : may mask hypogl­ycemia Asthma: symptoms to monitor for
Nursing Implic­ations Monitor heart rate and blood pressure Monitor for symptoms of HF
Drug Intera­ctions: cautious use with diabetics and asthma patients
Nursing Intera­ctions: Monitor pulse and BP regularly. IV admini­str­ation short onset and duration

Hypert­ensive Crisis

Sudden, severe increase in diastolic BP
Clinical manife­sta­tions: Hypert­ensive enceph­alo­pathy Renal insuff­iciency Cardiac decomp­ens­ation Neurologic compromise
Hypert­ensive Crisis: Nursin­g-C­oll­abo­rative Management
Hospit­ali­zation IV antihy­per­tensive drugs Intensive monitoring Invasive blood pressure monitoring Frequent physical assess­ments Treatment guided by MAP Use caution not to decrease BP too fast!

Types of Medica­tions

Diuretics
Beta-B­lockers
Calcium Channel Blockers
ACE Inhibitors
ARBs
Vasodi­lators

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